血液透析患者感染的菌群分布和耐药性分析

The distributing and insecticide tolerance analyse of flora that cause infection on hemodialysis sufferer

目的了解引起血液透析感染菌群分布及耐药情况。方法用K-B法进行药敏试验,对革兰阴性菌采用ESBLs确认试验检测ESBLs,头孢西丁三维试验检测AmpC。结果本组分离的259株细菌中,革兰阴性菌179株,占69.1%,主要致病菌为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌。革兰阳性菌80株,占30.9%,以金黄色葡萄球菌、凝固酶阴性葡萄球菌居前2位。革兰阴性杆菌ESBLs、AmpC酶总检出率分别为42.4%、39.1%,单产ESBLs、单产AmpC、同产ESBLs+高产AmpC酶、ESBLs+诱导AmpC酶菌株依次占15.6%、12.3%、16.8%、10.1%。革兰阳性分离株除对万古霉素、替考拉宁、喹奴普汀-达福普汀、利福平的耐药率较低外,其余抗生素的耐药率均大于50.0%。革兰阴性分离株对亚胺培南、美罗培南、头孢哌酮/他唑巴坦的耐药率分别为5.02%、3.35%和6.70%,产酶株较非产酶株具有较高的耐药率。结论血液透析患者细菌感染以金黄色葡萄球菌、凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌为主,万古霉素、替考拉宁对革兰阳性菌,亚胺培南、美罗培南和头孢哌酮/他唑巴坦对革兰阴性菌具有良好的抗菌活性。

Objective To know the distributing and insecticide tolerance of flora which course the infection on hemodialysis sufferer. Methods Drug sensitive test by K-B coating, detected ESBLs by ESBLs affirm test and detected AmpC by Cefoxitin three dimensional test during G^- bacterium. Results During the 259 bacteriums which separated from this group,179 strains were G^- （69.1%） , primary pathogenic bacteria of that were E. coli, K. pneumoniae, Enterobacter cloacae , at the same time, 80 strains were G^＋ （ 30.9% ）, ahead of them were Staphylococcus aureus and coagulase-negative staphylococci（CNS）. The detectable rate of ESBLs and AmpC were 42.4% and 39. 1% in G^- ,thereinto, single birth of ESBLs occupied 15.6%, that of AmpC was 12.3%, high yield AmpC amalgamated ESBLs occupied 16.8%, and inducement AmpC amalgamated ESBLs occupied 10.1%. Otherwise, the rate of tolerance of antibiotics were all higher than 50% except VAN,TEC,QDA and Rifampin in G^＋. The rate of tolerance to IPM, MEM,CSL were 5.02% ,3.35%, 6.70% separately in G^-, and the enzyme-procreant G^＋ were much moredrug toleranced than that without enzyme. Conclusions Basically,pathogenic bacteria which caused infection on hemodialysis sufferer were Staphylococcus aureus, coagulase-negative staphylococci（CNS） , E. coli, K. pneumoniae, and Enterobaeter cloacae, it was more nicer antibiotic effect that VAN and TEC to G^＋ ,IPM, MEM and CSL to G^-.